Cassio M. Turra

Mortality among elderly Hispanics in the United States: past evidence and new results.

We used vital records and census data and Medicare and NUMIDENT records to estimate age-and sex-specific death rates for elderly non-Hispanic whites and Hispanics, including five Hispanic subgroups: persons born in Cuba, Mexico, Puerto Rico, other foreign countries, and the United States. We found that corrections for data errors in vital and census records lead to substantial changes in death rates for Hispanics and that conventionally constructed Hispanic death rates are lower than rates based on Medicare-NUMIDENT records. Both sources revealed a Hispanic mortality advantage relative to non-Hispanic whites that holds for most Hispanic subgroups. We also present a new methodology for inferring Hispanic origin from a combination of surname, given name, and county of residence.

Socioeconomic Gradients in Health for White and Mexican-Origin Populations

OBJECTIVES We assessed whether the few findings to date suggesting weak relationships between education and health-related variables among Hispanics are indicative of a more widespread pattern. METHODS We used logistic regression models to examine education differentials (i.e., education gradients) in health behaviors and outcomes among White and Mexican-origin adults, adolescents, and infants. We gathered information from 3 data sets: the Los Angeles Family and Neighborhood Survey, the Fragile Families and Child Wellbeing Study, and the National Health Interview Survey. RESULTS In contrast with patterns for Whites, education was weakly associated or not associated with numerous health-related variables among the US Mexican-origin population. Among adults, Mexican immigrants were especially likely to have weaker education gradients than Whites. CONCLUSIONS The weak relationships between education and health observed among individuals of Mexican origin may have been the result of several complex mechanisms: social gradients in health in Mexico that differ from those in the United States, selective immigration according to health and socioeconomic status, and particular patterns of integration of Mexican immigrants into US society.

The Impact of Health Status and Out-of-Pocket Medical Expenditures on Annuity Valuation

This paper describes how differences in health status at retirement can influence the decision to purchase a life annuity. We extend previous research on annuitization decisions by incorporating the effect of health differentials via differences in survival throughout the latter portion of life. Next, we consider how precautionary savings motivated by uncertain out-of-pocket medical expenses influence annuitization decisions. Our results show that annuities become less attractive to people facing uncertain medical expenses. While full annuitization would still be optimal if annuity markets were truly complete and both life- and health-contingent, lacking this, annuity equivalent wealth values are much lower for those in poor health, as compared to persons in good health.

Do biological measures mediate the relationship between education and health: a comparative study

Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinical markers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data sets - the Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA - in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences.

Trends in healthy life expectancy among older Brazilian women between 1998 and 2008

OBJECTIVE To analyze conditional and unconditional healthy life expectancy among older Brazilian women. METHODS This cross-sectional study used the intercensal technique to estimate, in the absence of longitudinal data, healthy life expectancy that is conditional and unconditional on the individual’s current health status. The data used were obtained from the Pesquisa Nacional por Amostra de Domicílios (National Household Sample Survey) of 1998, 2003, and 2008. This sample comprised 11,171; 13,694; and 16,259 women aged 65 years or more, respectively. Complete mortality tables from the Brazilian Institute of Geography and Statistics for the years 2001 and 2006 were also used. The definition of health status was based on the difficulty in performing activities of daily living. RESULTS The remaining lifetime was strongly dependent on the current health status of the older women. Between 1998 and 2003, the amount of time lived with disability for healthy women at age 65 was 9.8%. This percentage increased to 66.2% when the women already presented some disability at age 65. Temporal analysis showed that the active life expectancy of the women at age 65 increased between 1998-2003 (19.3 years) and 2003-2008 (19.4 years). However, life years gained have been mainly focused on the unhealthy state. CONCLUSIONS Analysis of conditional and unconditional life expectancy indicated that live years gained are a result of the decline of mortality in unhealthy states. This pattern suggests that there has been no reduction in morbidity among older women in Brazil between 1998 and 2008.

Associação entre mortalidade e estado marital: uma análise para idosos residentes no Município de São Paulo, Brasil, Estudo SABE, 2000 e 2006

Este trabalho tem como objetivo analisar, para a populacao com 60 anos e mais, residente no Municipio de Sao Paulo, Brasil, a associacao entre mortalidade e estado marital. Para atingir o objetivo proposto, foram utilizados os dados do Estudo SABE: Saude, Bem-estar e Envelhecimento (SABE), realizado nos anos 2000 e 2006, e modelos de Regressao de Poisson foram estimados, levando-se, em consideracao, a variacao do tempo de risco de morte. No geral, os resultados indicam que, entre os idosos paulistanos do sexo masculino, a taxa de mortalidade dos solteiros e 61% maior que a taxa de mortalidade observada para os casados. Por sua vez, a separacao/divorcio ou a viuvez parece elevar a chance de morte das mulheres idosas analisadas. No geral, idosas separadas e viuvas apresentaram taxas de mortalidade 82% e 35% maiores que a observada para as casadas. Espera-se que este trabalho possa contribuir para um melhor entendimento dos fatores associados a sobrevivencia dos idosos, alem de subsidiar politicas de saude voltadas para esse contingente populacional.The aim of this study was to investigate the association between markers of oral disease and geographical factors influencing access to dental care (DMFT score) among school children in Central Mexico. Retrospective data were collected during an international service-learning program between 2002 and 2009. A sample of 1,143 children (55% females; mean age 12.7±13.1years) was analyzed. The mean DMFT score, represented largely by untreated tooth decay, was 4.02 (4.76). The variables that had the most significant effect on the DMFT score were proportion of paved roads between the community and dental services, and the availability of piped potable water. The DMFT score increased in proportion to the percentage of paved roads. In contrast, the DMFT score decreased with the availability of piped potable water. Similar results were found for untreated tooth decay. The main variable associated with a significant increase in dental fillings was proportion of paved roads. Together with Brazilian reports, this is one of the first investigations of the association between geographical factors and oral health in an underdeveloped setting.El estudio caracterizo la asociacion entre marcadores de salud bucal y de acceso deficiente a servicios dentales con variables geograficas. Se realizo un analisis retrospectivo de datos (recogidos de 2002 a 2009) de 1.143 ninos (55% mujeres; edad media 12,7±13,1 anos). El CPOD fue 4,02 (4,76), constituido primordialmente por caries sin tratar. Las variables con el mayor efecto sobre el CPOD fueron la proporcion de caminos pavimentados entre el termino municipal principal y comunidades aledanas, y la disponibilidad de agua potable entubada en estas ultimas. El CPOD aumento conforme lo hizo la proporcion de los caminos pavimentados. Por el contrario, el CPOD disminuyo moderadamente conforme la disponibilidad de agua potable aumento. La caries sin tratar exhibio tendencias similares. La unica variable fuertemente asociada a un mayor numero de tratamientos dentales fue la proporcion de caminos pavimentados. Conjuntamente con informes brasilenos, este es uno de los primeros estudios sobre la asociacion de factores geograficos y salud bucodental en un entorno menos desarrollo.

Survival of patients with operable breast cancer (Stages I-III) at a Brazilian public hospital--a closer look into cause-specific mortality.

BackgroundBreast cancer incidence is increasing. The survival rate varies and is longer in high-income countries. In Brazil, lower-income populations rely on the Unified Public Health System (Sistema Único de Saude, SUS) for breast cancer care. The goal of our study is to evaluate the survival of patients with operable breast cancer stages I-III at a Brazilian public hospital that treats mostly patients from the SUS.MethodsA cohort study of patients who underwent surgery for breast cancer treatment at the Clinical Hospital of the Federal University of Minas Gerais from 2001 to 2008 was performed, with a population of 897 cases. Information on tumor pathology and staging, as well as patients’ age and type of health coverage (SUS or private system) was collected. A probabilistic record linkage was performed with the database of the Mortality Information System to identify patients who died by December 31th, 2011. The basic cause of death was retrieved, and breast cancer-specific survival rates were estimated with the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis of factors related to survival.ResultsA total of 282 deaths occurred during the study’s period, 228 of them due to breast cancer. Five-year breast cancer-specific survival rates were 95.5% for stage I, 85.1% for stage II and 62.1% for stage III disease. Patients from the SUS had higher stages at diagnosis (42% was in stage III, and from the private system only 17.6% was in this stage), and in the univariate but not multivariate analysis, being treated by the SUS was associated with shorter survival (hazard ratio, HR = 2.22, 95% CI 1.24-3.98). In the multivariate analysis, larger tumor size, higher histologic grade, higher number of positive nodes and age older than 70 years were associated with a shorter breast cancer-specific survival.ConclusionsFive-year breast cancer survival was comparable to other Brazilian cohorts. Patients treated by the SUS, rather than by the private system, had shorter survival times, mostly due to higher initial stage of the disease.

Association between marital status and mortality among elderly residents in São Paulo City, Brazil, SABE Study, 2000 and 2006

This study aimed to analyze the association between mortality and marital status in the elderly population (60 years and older) in São Paulo, Brazil. The authors used data from the SABE Study (Health, Well-Being, and Aging) from 2000 and 2006. Statistical analysis used Poisson regression, considering variation in time of mortality risk. The mortality rate among single elderly males was 61% higher than among married men. Separation or divorce and widowhood increased the odds of death in elderly women (separated/divorced women and widows showed mortality rates 82% and 35% higher, respectively, than married women). It is hoped that the current study will improve our understanding of factors associated with survival in the elderly, in addition to supporting health policies for this population group.

Diferenciais de mortalidade: níveis e padrões segundo o sexo no município de São Paulo de 1920 a 2005

The aim of this study is to systematically analyze levels and patterns of sex differential in mortality rates in the city of Sao Paulo for a period of 85 years (1920-2005). Three indicators are used: the hiatus in life expectancy at birth; ratio between sexes among specific mortality rates by age; contribution of different ages in the hiatus in life expectancy at birth, based on the method of decomposing difference of life expectancy at birth proposed by the UN (1982). Generally, period trends observed in the city of Sao Paulo are similar to those found in developed countries, with some specificities. There is a temporal gap of 30 to 50 years in the long-term trend in the sex differential in mortality rate. The onset of the transition from age group to sex diferential was late, but it has become similar to developed countries more recently. Moreover, the analysis of different age contribution to the life expectancy at birth hiatus indicates that the decrease in the differential of the last five years is explained mainly by the decrease in male mortality at young ages. The decrease in death risk among adults and the elderly has also contributed to a significant percentage (about 30%) of the decrease in sex differential in mortality rates in this period. Thus, the results here shown suggest that the future behavior of sex differential in mortality rates will depend greatly on the heterogeneity of the death risk in advanced ages.

The Effect of Changes in Educational Composition on Adult Female Mortality in Brazil

The last century in Brazil was witness to profound changes. Female life expectancy at birth increased from 34.6 years in 1910 to 77.26 years in 2010. At the same time, the educational composition of the population has changed dramatically. In the 1940s, only 25% of the children aged 5–14 years old were enrolled in school. Currently, nearly all children attend school. We examine the extent to which changes in the age-specific distribution of education have contributed to the decline in adult mortality among women in Brazil. Our analysis follows other applications in the literature to measure the mortality reduction that would occur if exposure to specific risk factors was changed at the counterfactual level. The effects are not trivial: Between 1960 and 2010, about 38% of the increase in life expectancy at age 30 can be attributed to changes in the educational composition of women. An additional 22% increase is expected until 2040.